Vertebral coloumn resections are the most challenging surgeies
especially if they are upper thoracic and more so in revision cases
12/M 4 years old operated FUC Pott’s Spine D3-D4 with kyphotic Deformity
Operated few years back by anterolateral decompression elsewhere
Now has presented with upper thoracic kyphosis of 109 degree
Neuro intact
Did an upper thoracic vertbral coloumn resection
Cord was adherent anteriorly so left part of post wall sticking to dura
Had to go upto c6
C5 wires I placed for extra support to prevent screw backing out
Got 60 degrees correction
There were few Neuromonitoring scares
But fortunately all recovered
So because of that didn’t push further correction
Although I had two places pleura breach which I sutured
No chest tube
Did in 2 stages
Stage 1 - 12 hrs
Disection rib resection and anterior plane formation and laminectomy and hardware placement cut 4 nerve roots each side
Packed the rib graft thinking it will survive in biological environment and not get wasted or infected and can be reused
Did second stage osteotomy and correction - 6 hrs
Too much adhesions